Toward an Efficient Method to Evaluate Peripheral Neuropathies

The diagnosis of peripheral polyneuropathies can be challenging. A structured diagnostic approach can help make the endeavor efficient and increases the diagnostic yield. This review is in two parts. In the first part, we present the elements of a structured approach that consists of a set of steps that leads to a full characterization of the clinical features of the neuropathy. Electrodiagnosis will be emphasized because it has a key role in accurately defining the pattern of nerve involvement and determining the underlying pathology. After characterization, a rational list of laboratory tests can be ordered. The second part of this review describes the clinical and pathologic features of common peripheral neuropathies. This review of neuropathies emphasizes how the structured approach can facilitate the diagnosis. The second part concludes with the practical experience from evaluating peripheral neuropathies, emphasizing the point that a diagnosis may not be forthcoming in a third or more of patients.